Solving the Sleep Epidemic

Sometimes reading was the culprit. Sometimes, video games. Most often, just social anxiety.

Regardless of what kept Tyler Lifke awake, his middle-school years were dogged by a lack of sleep and depression.

“A therapist suggested that, instead of looking at antidepressants, we look at fixing my sleep,” Lifke said. “’How much sleep are you getting?’ she asked. ‘Like, four to six hours,’ I said. ‘Well, middle- schoolers should be getting closer to 10,’ she replied.

“Before that I didn’t have a concept of sleep being important. But once I realized that when I fixed my sleep my depression went away, [I decided] OK, it’s time to prioritize sleep above everything else,” Lifke said. “I’ve found since then that when I’m getting good sleep I can do everything better.”

By the time he arrived at St. Thomas in 2014, he had better sleep habits than many of his peers, which tended to skew toward the stereotypical behavior associated with college demands.

“Some people say that in college you’ve got academics, social life and sleep, and you can pick two of those, right?” Lifke said.

Opting to neglect the latter of those options has long been a staple of college life for many students, but at St. Thomas, psychology Professor Roxanne Prichard and Associate Director of Health and Wellness Birdie Cunningham are finding just how problematic that choice can be. Through the Center for College Sleep (CCS) and the Wellness Center, they are addressing students’ sleep issues. They provide programming at St. Thomas and resources to other schools across the country with a partnership that is the first of its kind.

“It feels like we can make a positive difference in students’ lives with this,” Cunningham said.

A pressing sleep problem

While the Center for College Sleep officially launched in the fall of 2015, its roots go back to 2010, when Prichard first published research on sleep patterns and disruptions in a college environment.

“My background is in the neuroscience of sleep, so studying rat brains [in the lab], which is what I came to St. Thomas to do,” Prichard said. “That first big study on St. Thomas students [after shifting away from rat studies] … had more than 100 citations [in other research articles] in the first year, which was more than all my other articles combined.”

By dedicating her research to college students and sleep, Prichard was delving into an extremely under-studied area; she said college students’ sleep habits are assumed to be bad, so they often are completely overlooked by researchers.

“We wanted to know how bad they are, and what can change,” Prichard said.

In the years since, research at the sleep center has highlighted how big a problem not sleeping well truly is. Findings from St. Thomas studies indicate that a lack of sleep’s effect on GPA is on par with marijuana use and binge drinking. Students not getting enough sleep are three times more likely to attempt suicide. And college-aged students have the highest death rates behind the wheel under the age of 80, according to Prichard.

“I think of it as a silent epidemic, and it’s so prevalent you can’t even see it,” Prichard added. “It’s so impactful.”

A unique partnership

Winding back to 2010, Cunningham and Prichard’s coming together proved serendipitous in many ways. Around the time Prichard was looking at St. Thomas students’ sleep, Cunningham was finding alarming results in the university’s annual health survey.

“I noticed sleep was a real prevalent stresser for St. Thomas students and that they weren’t sleeping well,” Cunningham said. “One of the survey questions is, ‘What do you find most traumatic?’ Academics was consistently first and sleep was second or third along with finances. What? Sleep? I couldn’t quite understand it. I started reaching out and trying to figure out what we could do.”

Cunningham quickly learned about Prichard’s work and a rare, possibly unique, partnership was formed.

“My perspective to that point was that all I needed to do was get a paper out. Meeting with Birdie was great because she said, ‘No, we have to get this into action, immediately, and here’s how you do it.’ I had never been in the world of student affairs, so it was great to team up with a group that can use the information to translate what’s feasible and not,” Prichard said, adding that the center’s partnership is the first of its kind between student affairs and research.

Over nearly eight years, that collaboration has continued to grow in scope and produced incredible results, with more than two dozen published research articles and presentations by Prichard, Cunningham and St. Thomas students. Specific programs for St. Thomas students have shown strong results, from the initial pilot program of a breakfast club that helped regulate participants’ sleep over three weeks, to a sleep challenge that now twice a year tracks students’ sleep for a month, to the development of student sleep ambassadors employed by the Wellness Center.

“We’re better when we sleep, period,” said senior Chris Hornung, a sleep ambassador who also started Tommies Unplugged, which works to improve students’ relationship with technology and sleep. Last year Hornung completed a research project correlating cell phone use to sleep deprivation – a prevalent finding in an age when social media and other digital platforms always are ready and waiting.

“Working with [Cunningham and Prichard] has absolutely raised my awareness of the importance of this issue,” Hornung said. “And they’ve given me the leadership by saying, ‘You now understand how important this is. You need to explain to everyone else why it is, too.’”

A national hub

The sleep center aims to increase awareness of sleep’s impact on every aspect of college students’ lives, not just at St. Thomas.

“Twice the amount of students [nationally] say they want more information about sleep than the amount who are getting it,” Prichard said. “That’s a big discrepancy.”

Enter the College Sleep Questionnaire (CSQ) and the College Sleep Environmental Scan, which are the lynchpin tools the sleep center has developed to give schools across the country the ability to understand their students’ sleep patterns and what they can do better to help them. The CSQ is an extensive survey given to students that assesses sleep schedule, physiological impediments to sleep and behavior impediments to sleep. It then offers customized feedback with information and direction to resources at that students’ school or nearby. About a half dozen schools around the country are testing the CSQ and providing feedback to the St. Thomas center; eventually it will be a packaged product for schools to purchase and use.

The free College Sleep Environmental Scan was developed in 2014 and offers an assessment for residential schools about how institutional policy, programming and structures contribute to or impede healthy sleep. More than 50 schools have used the tool, which also offers a wide range of ideas of how to address issues and implement best practices. Cunningham hopes one day to have a rating system similar to Leadership in Energy and Environmental Design (LEED)’s, which would signify a school’s priority of sleep as an important factor of life for its students.

“The scan is really strategic for how to address sleep on your campus, from easy fixes to five-year plans,” Cunningham said.

The center collects all the data into one sleep information hub for higher education to use as a resource. An executive summary each July is one way Prichard and Cunningham have made sure schools are learning from one another and finding ways to help their students sleep, and be, better.

Bigger and bigger

Especially since the sleep center’s launch, demand for Prichard and Cunningham’s expertise has grown. At St. Thomas, they have partnered with many athletic teams to help ensure sleep is factored into practice and traveling schedules. Prichard’s neuroscience sleep capstone course is a coveted experience for undergraduate students, dozens of whom also have contributed research.

Prichard and Cunningham have traveled around the country presenting their work, from a TedX talk to sleep forums – six-hour-long crash courses in Sleep 101 on Campus, which they have presented at institutions such as University of California-Davis and University of Arizona. They also work with the Minnesota Sleep Society and Minnesota Governors Highway Safety Association, helping both groups make policy decisions that address the sleep epidemic.

Most recently, the National Collegiate Athletic Association tapped Cunningham and Prichard to help develop its guidelines on sleep for college athletes, with Prichard’s research and Cunningham’s program development knowledge working hand-in-hand with leading sleep experts. “Those who work with the NCAA are the who’s who of the sleep world,” Cunningham said.

Prichard and Cunningham have years of experience working with college athletes due to their early emphasis on partnering with St. Thomas teams: Hundreds of athletes across several programs have benefited from partnering with the sleep center.

“Our players think the world of Dr. Prichard and Birdie Cunningham,” football coach Glenn Caruso said. “(Prichard) is a phenomenal specialist who also has tremendous common sense, and that’s something that is often lost in translation. You can find people who are very, very good at what they do in an academic setting, and that’s very important, but when you can translate that into real-world experience that actually will show results, that’s where you have something special. That’s what we have in the sleep center.”

Powerful sleep impact

As eager as Lifke was to talk about the sleep center and his research, tracking him down during the summer required some technological aid: He spent his break doing research at Washington University in St. Louis with a former student of Prichard’s, learning to spin electrodes and better measure the firing of neurons in the brain. Over Skype, Lifke described how, all these years after finding the personal importance of sleep to his own health, he can contribute to research that helps others.

“From an academic perspective, there are times researchers get away from the human side of what’s going on. The topic [of my research] is looking at the statistics that 1 percent of students are attempting suicide as a baseline rate, and when students aren’t getting their sleep, that climbs up to 3 percent of students. That’s a terrible statistic. It’s hard for me to separate the research aspect from the personal aspect in that case,” Lifke said.

“It is very humbling to realize the research I get to be part of will most likely get published, get out there and help inform people that sleep is something that matters. To me, the research is a means to an end, the end being the help for kids whose lives are really bad and want to end it.

“If a couple people read this paper on sleep and suicidality and think, ‘Maybe we should do a little bit better. In a college environment, what can we do to help people sleep?’ our research suggests that could save lives,” Lifke said. “That’s powerful. And it’s something I’m getting to be part of as an undergrad. It’s pretty incredible.”

Why sleep matters

• U.S. college students with excessive sleepiness are twice as likely to abuse prescription drugs.
• A person with insufficient sleep is nine times more likely to experience depression and 17 times
more likely to experience anxiety symptoms.
• A student experiencing sleep difficulties is 3.7 times more likely to seriously consider suicide than
a student with healthy sleep.
• A student diagnosed with insomnia is 11 times more likely to have attempted suicide than a student
without an insomnia diagnosis.
• On average, each additional day per week a student experiences sleep problems raises the probability
of dropping a course by 10 percent and lowers the cumulative GPA by .02.
• 85 percent of U.S. college students with sleep problems have not received help from their university
health services.National statistics gathered by the St. Thomas Center for College Sleep